Provider Demographics
NPI:1194004382
Name:KLEIN, LISA (LISA KLEIN)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:KLEIN
Suffix:
Gender:F
Credentials:LISA KLEIN
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:
Other - Last Name:KLEIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LISA KLEIN, MA LLPC
Mailing Address - Street 1:1090 N 10TH ST
Mailing Address - Street 2:SUITE 110
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49009-5733
Mailing Address - Country:US
Mailing Address - Phone:269-375-4363
Mailing Address - Fax:269-375-4362
Practice Address - Street 1:1090 N 10TH ST
Practice Address - Street 2:SUITE 110
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49009-5733
Practice Address - Country:US
Practice Address - Phone:269-375-4363
Practice Address - Fax:269-375-4362
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-05
Last Update Date:2011-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIL1997720101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional